MEDICARE: DEEPER WATERS COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083544563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEPER WATERS COUNSELING

Provider Business Mailing Address
First Line	:	467 PINE ST LOT 10
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-7077
Country	:	US
Telephone Number	:	912-278-4739
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 NE PARK AVE
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-0003
Country	:	US
Telephone Number	:	912-278-4739
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	ANGELA CANDACE THORNTON
Credential	:	LPC
Telephone Number	:	912-278-4739

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “DEEPER WATERS COUNSELING ” Practice Location

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